TY - JOUR
T1 - Kidney function and population-based outcomes of initiating oral atenolol versus metoprolol tartrate in older adults
AU - Fleet, Jamie L.
AU - Weir, Matthew A.
AU - McArthur, Eric
AU - Ozair, Sundus
AU - Devereaux, Philip J.
AU - Roberts, Matthew A.
AU - Jain, Arsh K.
AU - Garg, Amit X.
N1 - Funding Information:
Support: This project was conducted at the Institute for Clinical Evaluative Sciences (ICES) Western Site. ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). ICES Western is funded by an operating grant from the Academic Medical Organization of Southwestern Ontario . No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources.
Funding Information:
Financial Disclosures: Dr Garg received an investigator-initiated grant from Astellas and Roche for a Canadian Institutes of Health Research study in living kidney donors. His institution received an unrestricted grant from Pfizer for research unrelated to the following study. The authors declare that they have no other relevant financial interests.
Publisher Copyright:
© 2014 National Kidney Foundation, Inc.
PY - 2014/12
Y1 - 2014/12
N2 - Background Atenolol and metoprolol tartrate are commonly prescribed β-blockers. Atenolol elimination depends on kidney function, whereas metoprolol tartrate does not. We hypothesized that compared to metoprolol tartrate, initiating oral atenolol treatment would be associated with more adverse events in older adults, with the association most pronounced in patients with lower baseline estimated glomerular filtration rates (eGFRs).Study Design Population-based matched retrospective cohort study.Setting & Participants Older adults (mean age, 75 years) in Ontario, Canada, prescribed oral atenolol versus metoprolol tartrate from April 2002 through December 2011. The 2 groups were well matched (n = 75,257 in each group), with no difference in 31 measured baseline characteristics. Patients with end-stage renal disease were ineligible, and 4.6% of patients had chronic kidney disease (median eGFR, 38 mL/min/1.73 m2 assessed through a database algorithm).Predictors β-Blocker type and eGFR.Outcomes A composite outcome of hospitalization with bradycardia or hypotension and all-cause mortality were assessed in 90-day follow-up.Results Compared to metoprolol tartrate, initiating atenolol treatment was not associated with higher risk of hospitalization with bradycardia or hypotension (incidence, 0.71% vs 0.79%; relative risk, 0.90; 95% CI, 0.80-1.01). Atenolol treatment initiation was associated with lower 90-day risk of mortality than metoprolol tartrate (incidence, 0.97% vs 1.44%; relative risk, 0.68; 95% CI, 0.61-0.74). Lower eGFR did not modify either association (P for interaction = 0.5 and 0.6, respectively).Limitations Heart rate and blood pressure were not available in our data sources, and effects ascertained from observational studies are subject to residual confounding.Conclusions Contrary to our expectation, we found that atenolol versus metoprolol tartrate was associated with lower 90-day risk of mortality in patients regardless of eGFR, with no difference in risk of hospitalization with bradycardia or hypotension.
AB - Background Atenolol and metoprolol tartrate are commonly prescribed β-blockers. Atenolol elimination depends on kidney function, whereas metoprolol tartrate does not. We hypothesized that compared to metoprolol tartrate, initiating oral atenolol treatment would be associated with more adverse events in older adults, with the association most pronounced in patients with lower baseline estimated glomerular filtration rates (eGFRs).Study Design Population-based matched retrospective cohort study.Setting & Participants Older adults (mean age, 75 years) in Ontario, Canada, prescribed oral atenolol versus metoprolol tartrate from April 2002 through December 2011. The 2 groups were well matched (n = 75,257 in each group), with no difference in 31 measured baseline characteristics. Patients with end-stage renal disease were ineligible, and 4.6% of patients had chronic kidney disease (median eGFR, 38 mL/min/1.73 m2 assessed through a database algorithm).Predictors β-Blocker type and eGFR.Outcomes A composite outcome of hospitalization with bradycardia or hypotension and all-cause mortality were assessed in 90-day follow-up.Results Compared to metoprolol tartrate, initiating atenolol treatment was not associated with higher risk of hospitalization with bradycardia or hypotension (incidence, 0.71% vs 0.79%; relative risk, 0.90; 95% CI, 0.80-1.01). Atenolol treatment initiation was associated with lower 90-day risk of mortality than metoprolol tartrate (incidence, 0.97% vs 1.44%; relative risk, 0.68; 95% CI, 0.61-0.74). Lower eGFR did not modify either association (P for interaction = 0.5 and 0.6, respectively).Limitations Heart rate and blood pressure were not available in our data sources, and effects ascertained from observational studies are subject to residual confounding.Conclusions Contrary to our expectation, we found that atenolol versus metoprolol tartrate was associated with lower 90-day risk of mortality in patients regardless of eGFR, with no difference in risk of hospitalization with bradycardia or hypotension.
KW - adverse events
KW - Atenolol
KW - beta-blocker
KW - bradycardia
KW - chronic kidney disease (CKD)
KW - drug safety
KW - elderly
KW - hypotension
KW - metoprolol tartrate
KW - older adults
KW - renal function
UR - http://www.scopus.com/inward/record.url?scp=84911382910&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2014.06.009
DO - 10.1053/j.ajkd.2014.06.009
M3 - Article
C2 - 25037562
AN - SCOPUS:84911382910
SN - 0272-6386
VL - 64
SP - 883
EP - 891
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -